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HEMODYNAMICS IN THE IMMEDIATE POSTOPERATIVE PERIOD AFTER LIVER TRANSPLANTATION IN ALCOHOLIC AND POSTVIRAL CIRRHOSIS

W Al-Hamoudi¹, S Al-qahtani¹, M Ma², SS Lee¹
¹Liver Unit, University of Calgary, Calgary; ²Alberta Liver Transplantation Program, University of Alberta, Edmonton, Alberta

BACKGROUND/AIMS: Cirrhosis is associated with hyperdynamic circulation and pulmonary vascular abnormalities, whether these abnormalities persist in the immediate post-transplantion, and differ according to the cause of cirrhosis remains unclear. Therefore, we examined immediate postoperative hemodynamics in patients with alcoholic vs viral (hepatitis B or C) cirrhosis.
METHODS: Between 2000-2003, 38 patients were transplanted for alcoholic cirrhosis and 28 for postviral cirrhosis. Systemic and pulmonary hemodynamic parameters were measured immediately and 24 hours post transplantation.
RESULTS: Hyperdynamic circulation persisted within the first 24 hours following liver transplantation. Within the first 24 hours, there was a significant decrease in HR and increase in MAP; extent of change was similar in the two groups. The CVP, PCWP and SVRI increased, and CI decreased in the viral but not the alcoholic patients. Alcoholics showed a lower PVRI and PAP compared to the viral group at 24 hours.
CONCLUSIONS: These results indicate that although the hyperdynamic circulation persists in the immediate post-transplant period, systemic parameters improve faster in the viral group. Pulmonary hemodynamics differ significantly between alcoholic and postviral patients within the first 24 hours, suggesting that alcoholics may have more pronounced pulmonary vasodilation than viral-cirrhotic patients.

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